General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 881: Amputation is often not required in:

A. Buerger's
B. Chronic osteomyelitis (Correct Answer)
C. Diabetic gangrene
D. Gas gangrene

Explanation: ***Chronic osteomyelitis*** - While chronic osteomyelitis can be severe, advancements in **antibiotic therapy**, **surgical debridement**, and **reconstructive procedures** often allow for limb salvage. - The goal of treatment is to eradicate infection and preserve function, making amputation a last resort when other methods fail to control infection or restore viability. *Buerger's* - **Buerger's disease** (thromboangiitis obliterans) is characterized by inflammation and thrombosis of small and medium-sized arteries and veins, primarily in the limbs, leading to severe ischemia and gangrene. - Due to progressive vascular damage and frequent lack of effective medical treatment for advanced stages, **amputation is often required** to remove necrotic tissue and manage intractable pain. *diabetic gangrene* - **Diabetic gangrene** results from a combination of **peripheral neuropathy**, **peripheral arterial disease**, and **infection**, leading to tissue death, particularly in the feet. - The compromised blood supply and impaired wound healing in diabetic patients make these lesions prone to rapid progression and severe infection, with **amputation frequently necessary** to prevent systemic sepsis and death. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by *Clostridium* species, which produce toxins and gas within tissues. - Due to its aggressive and destructive nature, requiring immediate and extensive surgical debridement often involving **amputation of the affected limb** to remove all infected tissue and prevent widespread systemic toxicity.

Question 882: Most common cause of esophageal perforation at the site of cricopharynx -

A. Spontaneous
B. Iatrogenic (Correct Answer)
C. Foreign body
D. Traumatic

Explanation: ***Iatrogenic*** - Most esophageal perforations, especially at the cricopharyngeal level, are **iatrogenic**, typically occurring during **endoscopic procedures** such as esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE), or esophageal dilation. - The cricopharynx (or upper esophageal sphincter) is a narrow, relatively weak area of the esophagus, making it susceptible to injury during instrument passage. - Accounts for approximately **50-70%** of all esophageal perforations at this site. *Spontaneous* - Spontaneous esophageal perforation (Boerhaave syndrome) usually occurs in the **distal esophagus** following episodes of severe retching and vomiting. - It is far less common in the cervical esophagus or cricopharyngeal region compared to iatrogenic causes. *Foreign body* - Foreign body impaction can cause esophageal perforation, particularly at anatomical narrowing points. - However, at the cricopharynx level, **iatrogenic injury during endoscopic removal** of foreign bodies is more common than direct perforation from the foreign body itself. *Traumatic* - **External blunt or penetrating trauma** to the neck can cause esophageal perforation, but this is less common than iatrogenic causes at the cricopharynx. - While trauma can certainly cause perforation, instrument-related perforations during medical procedures are statistically more frequent in this area.

Question 883: Incomplete casting can be due to:

A. Low casting pressure.
B. Insufficient venting.
C. Inadequate or too small sprue.
D. All of the options. (Correct Answer)

Explanation: ***All of the options.*** - All listed factors—**low casting pressure**, **insufficient venting**, and an **inadequate or too small sprue**—can prevent molten metal from completely filling the mold cavity during casting. - Incomplete casting is a common issue in foundry practice, and addressing these collective issues is crucial for achieving high-quality castings. *Low casting pressure.* - **Low casting pressure** means the molten metal is not pushed into the mold cavity with enough force to completely fill all parts. - This can lead to **voids** or **unfilled sections** in the final cast object. *Insufficient venting.* - When there is **insufficient venting**, trapped gases within the mold cannot escape as the molten metal fills the cavity. - This results in **incomplete filling** and porosity, as the gas pockets block the flow of metal. *Inadequate or too small sprue.* - A **sprue** that is either **inadequate** in design or **too small** in diameter restricts the flow of molten metal into the mold. - This limitation in metal flow can prevent the mold from being entirely filled, leading to incomplete casting.

Question 884: The material used in vertebroplasty is -

A. Polyethyl methacrylate
B. Isomethyl methacrylate
C. Polymethyl methacrylate (Correct Answer)
D. Isoethyl methacrylate

Explanation: ***Polymethyl methacrylate*** - **Polymethyl methacrylate (PMMA)** is a commonly used **bone cement** in vertebroplasty due to its biocompatibility and mechanical properties. - PMMA rapidly polymerizes in situ, providing **structural support** and **stabilization** to the fractured vertebral body. *Polyethyl methacrylate* - **Polyethyl methacrylate** is another acrylic polymer, but it is less commonly used as a bone cement in vertebroplasty compared to PMMA. - It might have different handling characteristics or mechanical strength than PMMA, making it less ideal for this specific procedure. *Isomethyl methacrylate* - **Isomethyl methacrylate** is not a standard or recognized bone cement used in vertebroplasty. - The prefix "iso-" indicates an isomer, but this specific compound is not typically employed in medical procedures like vertebroplasty. *Isoethyl methacrylate* - **Isoethyl methacrylate** is also not a recognized or standard material used for bone cement in vertebroplasty. - Similar to isomethyl methacrylate, it is not a widely adopted or suitable material for providing structural support in vertebral fractures.

Question 885: Pseudoclaudication is caused by:

A. Lumbar canal stenosis (Correct Answer)
B. Aortic aneurysm
C. Peripheral vascular disease
D. Spinal cord compression

Explanation: ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a classic symptom of **lumbar spinal stenosis**. - This condition involves narrowing of the **spinal canal**, which compresses the **nerve roots** and causes pain, numbness, or weakness in the legs during walking. *Aortic aneurysm* - An **aortic aneurysm** is a localized **dilation of the aorta** and typically causes symptoms due to **rupture**, **compression of adjacent structures**, or **thromboembolism**. - It does not directly cause gait-dependent leg symptoms that characterize pseudoclaudication. *Peripheral vascular disease* - **Peripheral vascular disease (PVD)** causes **vascular claudication**, which is characterized by reproducible muscle pain with exercise due to **ischemia**. - Unlike pseudoclaudication, PVD pain is typically relieved by **rest** and is less affected by posture. *Spinal cord compression* - While **spinal cord compression** can cause neurological deficits, it typically presents with **upper motor neuron signs** (e.g., hyperreflexia, spasticity) below the level of compression. - These symptoms are usually more constant and severe than the intermittent, posture-related symptoms of pseudoclaudication, which primarily affects nerve roots.

Question 886: Cushing ulcers are:-

A. Stress ulcers in hiatus hernia
B. Stress ulcers in burns
C. Stress ulcers in depression
D. Stress ulcers in head injury (Correct Answer)

Explanation: ***Stress ulcers in head injury*** - **Cushing ulcers** are acute **gastric or duodenal ulcers** that develop after a severe **head injury** or other central nervous system trauma. - The pathophysiology involves **vagal overstimulation** due to increased intracranial pressure, leading to hypersecretion of **gastric acid** and reduced mucosal blood flow. *Stress ulcers in hiatus hernia* - A **hiatus hernia** is a condition where part of the stomach protrudes through the diaphragm into the chest cavity, which can predispose to reflux and esophagitis. - While patients with hiatus hernia might develop ulcers, these are not specifically termed Cushing ulcers, and the primary cause is mechanical or reflux-related, not neurological. *Stress ulcers in burns* - **Stress ulcers** that occur in burn patients are known as **Curling ulcers**, not Cushing ulcers. - These are typically caused by **hypovolemia, vasoconstriction**, and **ischemia** of the gastrointestinal mucosa due to significant fluid loss and systemic inflammatory response. *Stress ulcers in depression* - **Depression** is a mood disorder that can influence gastrointestinal function through the **gut-brain axis**, potentially affecting motility and visceral hypersensitivity. - However, depression is not directly associated with the formation of acute stress ulcers like Cushing ulcers, which are primarily linked to severe CNS injury.

Question 887: Which statement about pilonidal sinus is false?

A. More common in males
B. Mostly occurs in midline
C. Usually occurs after 40 (Correct Answer)
D. Associated with obesity

Explanation: ***Usually occurs after 40*** - This statement is **false** because pilonidal sinus typically affects younger individuals, particularly those between **15 and 30 years of age**. - Its incidence significantly **decreases after the age of 40**, making late onset uncommon. *More common in males* - This statement is **true** as pilonidal sinus has a **higher prevalence in males** than females, with a male-to-female ratio of about 3:1 to 4:1. - This increased prevalence is often attributed to **hairiness** and certain occupational or lifestyle factors more common in men. *Mostly occurs in midline* - This statement is **true** as pilonidal sinuses primarily develop in the **natal cleft**, specifically in the **midline** between the buttocks. - They often begin as small pits or tracts at the top of the gluteal fold, allowing **hair and debris to collect**. *Associated with obesity* - This statement is **true** because **obesity** is a recognized risk factor for the development of pilonidal sinus. - Increased weight can lead to **deeper natal clefts** and increased skin friction, which can trap more hair and promote the formation of cysts and sinus tracts.

Question 888: A 50-year-old male presents with an irreducible groin swelling. What is the most likely diagnosis?

A. Femoral hernia
B. Inguinal hernia (Correct Answer)
C. Hydrocele
D. Lipoma

Explanation: ***Inguinal hernia*** - An **irreducible groin swelling** in a 50-year-old male is most commonly an incarcerated **inguinal hernia**, which is a surgical emergency. - **Inguinal hernias** are more prevalent in males due to the descent of the testes through the inguinal canal. *Femoral hernia* - While also presenting as a groin swelling and susceptible to irreducibility, **femoral hernias** are much more common in women. - They typically present as a swelling **below the inguinal ligament** and medial to the femoral vessels. *Hydrocele* - A **hydrocele** is a collection of fluid around the testis, which usually presents as a **transilluminable** scrotal swelling. - It is typically **reducible** and not associated with a mass in the groin proper. *Lipoma* - A **lipoma** is a benign fatty tumor that can occur anywhere in the body, including the groin. - However, unlike a hernia, it is typically **soft**, **mobile**, and generally **not irreducible** or associated with bowel contents.

Question 889: A 55-year-old male presents with a painful bulge in the groin that becomes more prominent when standing. Physical examination confirms an inguinal hernia. What is the definitive treatment?

A. Truss application
B. Observation
C. Antibiotic therapy
D. Hernioplasty (Correct Answer)

Explanation: ***Hernioplasty*** - **Hernioplasty** (mesh repair) is the definitive surgical treatment for inguinal hernia, involving either open (Lichtenstein) or laparoscopic (TEP/TAPP) approaches using mesh to reinforce the abdominal wall. - This procedure addresses the underlying anatomical defect, preventing complications such as **incarceration** or **strangulation**, which can be life-threatening. - Modern mesh-based repair has lower recurrence rates compared to traditional tissue repair (herniorrhaphy). *Truss application* - A **truss** is a supportive device that applies external pressure to the hernia site to keep it reduced. - It is considered a temporary measure to manage symptoms and is **not a definitive treatment** as it does not repair the structural defect. *Observation* - **Observation** alone may be considered in asymptomatic or minimally symptomatic patients with reducible hernias (watchful waiting). - However, this patient is **symptomatic** (painful bulge), making surgical repair the preferred definitive approach to prevent complications like **incarceration**. *Antibiotic therapy* - **Antibiotic therapy** is used to treat bacterial infections. - An **inguinal hernia** is a structural defect, not an infection, and therefore antibiotics are not a relevant treatment.

Question 890: An orthopedic surgeon is repairing a fracture in the distal radius. Which structure must be carefully protected because of its proximity to the surgical site?

A. Radial nerve
B. Median nerve (Correct Answer)
C. Ulnar nerve
D. Brachial artery

Explanation: ***Median nerve*** - The **median nerve** closely tracks the flexor tendons and is situated centrally in the wrist, making it highly vulnerable during distal radius fracture repair, especially in cases of displaced fractures or open reduction procedures. - Injury can lead to **carpal tunnel syndrome** symptoms, including numbness and weakness in parts of the hand innervated by the median nerve. *Radial nerve* - The **radial nerve** and its branches, such as the superficial radial nerve, are located on the dorsoradial aspect of the wrist. - While it can be injured, it is generally less commonly damaged during a standard distal radius fracture repair approach compared to the median nerve. *Ulnar nerve* - The **ulnar nerve** runs along the ulnar side of the wrist, within Guyon's canal, which is anatomically distinct from the primary surgical approaches to the distal radius. - Its distance from the typical surgical field for distal radius fractures makes it a less common site of iatrogenic injury during this specific procedure. *Brachial artery* - The **brachial artery** is located in the arm, proximal to the elbow, and is not in the immediate vicinity of a distal radius fracture repair. - Injury to the brachial artery is highly unlikely during surgery on the wrist.

Practice by Chapter

Wound Healing and Care

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Surgical Infections

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Fluid and Electrolyte Management

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Nutrition in Surgical Patients

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Hemostasis and Blood Transfusion

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Surgical Instruments and Equipment

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Sutures and Stapling Devices

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Minimal Access Surgery Principles

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Surgical Complications

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Anesthesia Principles for Surgeons

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Surgical Oncology Principles

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Evidence-Based Surgery

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